Tài liệu Pickard’s Manual of Operative Dentistry pptx

OXFORD MEDICAL PUBLICATIONS

Pickard’s Manual of

Operative Dentistry

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Professor HM Pickard 1909–2002

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Edwina A. M. Kidd

Professor of Cariology

Guy’s, King’s, and St Thomas’ Dental Institute

King’s College

London

Bernard G. N. Smith

Professor of Conservative Dentistry

Guy’s, King’s, and St Thomas’ Dental Institute

King’s College

London

Timothy F. Watson

Professor of Microscopy in Relation to Restorative Dentistry

Guy’s, King’s, and St Thomas’ Dental Institute

King’s College

London

Based on the first five editions of A manual of operative dentistry

H. M. Pickard

Emeritus Professor in Conservative Dentistry

University of London

Formerly of the Royal Dental Hospital of London School of Dental Surgery

Pickard’s Manual of

Operative Dentistry

Eighth edition

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Oxford University Press is a department of the University of Oxford.

Great Clarendon Street, Oxford OX2 6DP

It furthers the University’s objective of excellence in research, scholarship,

and education by publishing worldwide in

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Oxford is a registered trade mark of Oxford University Press

in the UK and in certain other countries

Published in the United States

by Oxford University Press Inc., New York

The moral rights of the author have been asserted

Database right Oxford University Press (maker)

First edition published 1961

Sixth edition published 1990

Seventh edition published 1996 (reprinted 1996, 1998 (twice), 2000)

Eighth edition published 2003

stored in a retrieval system, or transmitted, in any form or by any means,

without the prior permission in writing of Oxford University Press,

or as expressly permitted by law, or under terms agreed with the appropriate

reprographics rights organization. Enquiries concerning reproduction

outside the scope of the above should be sent to the Rights Department,

Oxford University Press, at the address above

You must not circulate this book in any other binding or cover

and you must impose this same condition on any acquirer

British Library Cataloguing in Publication Data

Data available

Library of Congress Cataloging in Publication Data

ISBN 0 19 850928 6

10 9 8 7 6 5 4 3 2 1

Typeset by EXPO Holdings, Malaysia

Printed in China

on acid-free paper by

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It is 41 years since the first edition of this book was published. In that time there have been so many developments in

our understanding of dental disease, in materials, and in

techniques so that there is now very little of that first edition

remaining except the basic philosophy for managing

patients with dental disease. This philosophy has several

parallel threads which weave together.

• Dentists primarily look after people with dental problems – not just mouths or teeth.

• An understanding of the disease processes is fundamental to their management.

• The diseases should be managed – not just treated.

• Prevention is the keystone of management. The effectiveness of the prevention of dental caries in a selected

group is shown by the fact that about three-quarters of

undergraduate dental students at our dental institute

now have no caries or restorations. Sadly, this is not yet

the case with all people of that generation.

• When treatment is needed, the development of excellent operative skills is still of paramount importance.

This can only be achieved by extensive supervised

clinical practice and chairside teaching which remain

as important as ever in the crowded undergraduate

curriculum. If students do not develop sufficient skill

during their undergraduate course there is little

opportunity for most dentists to develop basic skills in

a supervised setting after qualification.

• When active treatment is needed, the choice of materials and techniques should be based on a thorough

understanding of them and the advantages and disadvantages of the alternatives. This choice is getting

more difficult as the range of materials and techniques

increases so that an even greater understanding of the

properties of dental materials is now necessary.

One of the major developments since the seventh edition

has been the increased use of bonding techniques which in

turn allow much less destructive tooth preparation. For

example, in the seventh edition the use of amalgam for the

management of smooth surface lesions was deleted, and we

now feel that the evidence to support the use of composite

materials for occlusal lesions is sufficient for us to recommend that amalgam should no longer be used for occlusal

restorations. These developments justify a new chapter

(Chapter 6) which brings together parts of other chapters

from the last edition and adds substantial new material.

The intention is that this book contains the material a

student needs to know (except endodontic and periodontal

treatment) up to the point that crowns become necessary. In

other words, students can provide long-term stabilization,

including permanent intracoronal restorations and cores for

crowns, until they have learnt about crowns and then can

continue treating the same patients if that is the policy of their

undergraduate school. An increasing number of schools adopt

policies of ‘whole patient care’ and ‘continuity of care’ so that

students can manage their own patients and all their dental

needs from an early introduction through to the end of the

undergraduate course. In some schools this gives the students

three or more years of contact with some patients at regular

recalls after the initial course of treatment. During that time

they can move on to other procedures, as necessary, with the

same patient, for example crowns, bridges, and partial

dentures. They also have an opportunity to see the short-term

(one or two years) success or failure of their restorations.

Previous editions have included a brief list of ‘further

reading’ at the end of each chapter. This has been brought

up to date and retained but we suggest that readers use the

list of topics at the beginning of each chapter as ‘keywords’

to initiate their own computer search of the literature.

There are two significant, current educational and clinical

concepts which we believe we have developed further in this

edition. The first is ‘problem solving’ and the emphasis on

managing disease rather than treating it as an example of real

problem solving. The second concept is ‘evidence-based practice’. This is a manual of operative dentistry, not an authoritative textbook, however many of the changes in this edition

are based on recent research evidence. If evidence is considered as not just research-based scientific evidence but

includes the evidence of experience, then we believe that this

edition reflects the current state of play in operative dentistry.

We are considerably indebted to many colleagues who

have allowed us to use their illustrations. They are acknowledged in the captions to the relevant figures together with a

source of the original publication where applicable.

E. A. M. K.

B. G. N. S.

T. F. W.

March 2003

Preface to the eighth edition

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PART I DISEASES, DISORDERS, DIAGNOSIS,

DECISIONS, AND DESIGN

1 Why restore teeth? 5

Dental caries 5

The carious process and the carious lesion 6

Plaque retention and susceptible sites 6

Severity or rapidity of attack 7

The carious process in enamel 7

The carious process in dentine 9

Root caries 11

Secondary or recurrent caries 11

Residual caries 12

Diagnosis of dental caries 12

The diagnostic procedure 12

Assessment of caries risk 16

Symptoms of caries 18

The relevance of the diagnostic information to the

management of caries 18

Preventive, non-operative treatment 18

Patient involvement 19

Why is the patient a caries risk? 19

Mechanical plaque control 19

Use of fluoride 20

Dietary advice 20

Salivary flow 20

Operative treatment 20

Caries in pits and fissures 20

Approximal lesions 20

Smooth surfaces and root caries 20

Tooth wear 20

Erosion 22

Attrition 23

Abrasion 24

Summary of the causes of tooth wear 24

Acceptable and pathological levels of tooth wear 24

Consequences of pathological tooth wear 24

Diagnosing and monitoring tooth wear 24

Preventing tooth wear 27

The management of tooth wear 27

Contents

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viii Contents

Trauma 27

Aetiology of trauma 27

Examination and diagnosis of dental injury 28

Management of trauma to the teeth 28

Developmental defects 28

Acquired developmental conditions 28

Treatment of developmental defects 30

Hereditary conditions 30

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